The Prevalence and Associated Factors of Sexual Dysfunction Among Prostate Cancer Patients on Goserelin Androgen Deprivation Therapy in Kenyatta National Hospital

Abstract

Background: The main modality of prostate cancer treatment has been Androgen deprivation therapy (ADT) which has been demonstrated in randomized studies to enhance overall survival when utilized for radiation for intermediate and high risk localized disease as well as for locally advanced and node-positive disease and also for the nodepositive disease after surgery. Though ADT may enhance survival, it can cause serious morbidity and a decrease in life quality, the most significant of which is sexual dysfunction. There is no local study that has been done on this important subject and the studies elsewhere indicate that the prevalence of sexual dysfunction is high among this population. Objective: To determine the prevalence and factors that are associated with sexual dysfunction amongst prostate cancer patients on Goserelin Androgen deprivation therapy in Kenyatta National Hospital. Methods: This was a cross-sectional study done at Kenyatta National Hospital (KNH) Urology and Oncology outpatient clinics among patients who on follow-up for cancer of the prostate. Ninety-nine (99) were recruited through convenient sampling after giving consent. The principal researcher and two research assistants using a questionnaire collected the data. Each patient recruited into the study was given a special serialized number for purposes of ordering the data collection documents. Data on the demographics of patients, nutritional status, social habits, sexual function status using international index of erectile function (IIEF) score, disease stage, Goserelin dosage, duration of treatment, co-morbid and ECOG status was collected. Data analysis was done using statistical package for social sciences (SPSS) version 25. Bivariable analysis was done using pearson and Fischer’s exact test while binary logistic regression was used to conduct multivariable analysis. The level of significance was investigated at 0.05. Results: The average age of the participants was 70.4 (SD±8) years, the average body mass index was 29.6 (SD±3) kg/m². The mean baseline and current Prostate-Specific Antigen (PSA) was 673.6 (SD±59) ng/ml and 51.4 (SD±16) ng/ml respectively. The findings revealed that 90% (89) of the respondents had sexual dysfunction as shown in Figure 4.1 with a 95% CI (82.2, 95.1). Bi-variable analysis showed that, Alcohol and cigarette smoking, cOR =10.3, 95%CI: 2.0,53.04, p =0.005, tumor staging T4, cOR =16, 95%CI: 2.8, 92.4, p =0.002. very high NCCN risk classification, cOR = 9, 95%CI:1.9, 43.1, p =0.006 and symptomatic but completely ambulatory ECOG status cOR = 7.3, 95% CI:2.84,10.9, p=0.002 were found to be associated with sexual dysfunction. The independent risk factors associated with sexual dysfunction were alcohol and cigarette smoking, aOR = 5, 95% CI: 1.9, 14.6, p = 0.010 and tumor staging T4, aOR =11.1, 95% CI:4.6,32.1, p<0.009. Conclusion and recommendation: The findings have showed that majority of prostate cancer patients have sexual dysfunction with tumor staging, cigarette smoking and alcohol use key predictors. Thus, there is need educate prostate cancer patients on Goserelin ADT about getting extra psychosexual support and physical sexual therapy, as well as availing to patients’ options such as penile rehabilitation during hormone therapy.